Intro

Welcome to our Big News section for all the latest news concerning Military Disability.

We'll do our best to keep you up to date on everything that could affect your disability. Since the majority of our news will cover legal issues that can be dragged out for a long time, if you'd like an update on an issue, let us know, and we'll do what we can.

Please feel free to comment and submit questions. We want to give you the information you need, so help us by letting us know what you want to know.

Change 1. Currently, the VA does not
consider medical evidence of a condition that was found outside of the VA’s
medical system. So if you went to a non-VA physician, then the doctor’s notes
and tests from that physician are not used when determining a rating for VA
disability. Instead, the VA will request for your condition to be examined by a
VA physician and then rated based on the results of this exam.

This practice, however, will change if this
act passes into law. As long as there is enough evidence to properly rate a
condition, then the VA CANNOT request for another exam to be performed, even if
the evidence comes from outside the VA’s medical system. By being able to skip
a whole round of C&P Exams, this could really speed up the VA disability process in many
cases.

The key to this, however, is that the
outside medical records must have “enough evidence” to rate the condition. The
VA uses the laws of the VASRD to rate conditions for VA Disability. The
VASRD is very specific about the kinds of tests that must be performed and the
data that must be recorded in order to rate each condition. If the necessary
evidence is not properly recorded, then the VA will still have to perform
another exam to obtain this information.

For example, arthritis in the elbow is
predominantly rated on range of motion. If the outside physician recorded pain,
x-ray evidence of arthritis, etc., but no range of motion measurements, then
another exam will still have to be done to get those measurements.

It’s a good idea for you to know what
evidence is needed for your conditions so that you can make sure it is properly
recorded in every exam, including your C&P Exam (the VA physicians don’t always
know the right stuff to record either). This is something you can do that could
save you a great deal of time.

Change 2. Prestabilization ratings or “temporary
ratings” are given by the VA in cases where a condition is changing enough to
make it impossible to give it a permanent rating or where circumstances make it
difficult to give a permanent rating.

Currently, only 100% and 50% Military Disability Ratings are
given for conditions that are unstable. This act would add a 30% rating that
could also be given for unstable conditions. This would allow less severe
unstable conditions to receive a rating sooner since the VA would no longer
have to wait until it stabilizes to give a rating.

Similarly, the VA would be able to give a
temporary minimum rating for any condition that clearly qualifies for its
minimum rating. Each condition has different requirements for the different
ratings. As long as it is clear that it qualifies for its lowest rating, then
the minimum can go ahead and be given temporarily until the VA is able to fully
examine the case and give the condition a permanent rating. For example, the
minimum rating for hypertension (high blood pressure) is 10%. As long as the
veteran has to always take medication for this (the requirement for the
minimum), then the VA can go ahead and assign the minimum rating until they are
able to more closely review the case.

In return for quickly assigning these temporary
ratings, this law allows the VA to not report any cases with these ratings as
part of the backlog. This could be both good and bad. The good thing is that
the veterans will begin receiving compensation much more quickly. The bad,
however, is that since the VA has such a negative public focus on the backlog right now, they most likely will continue to just focus on that and not on finalizing the many cases that
are given these minimum ratings. So, a minimum rating allows the vets to
receive some compensation faster, but it will almost definitely still take
quite awhile before they receive their full ratings and the entire compensation that they need.

Change 3. This last change is simple. All
payments of benefits from the VA will be paid before the first of the month. So
instead of you receiving the February payment during February, they will have
it processed and sent out before February 1st. In my mind this
doesn’t make a huge difference in the grand scheme of things, but can make paying
monthly bills a bit easier, I guess, so there you go.

If this act makes it through Congress and
becomes law, then these changes will last for 6 years, as a sort of trial
period. I guess after that time, if they work, they’ll keep them, and if they
don’t, they’ll try something else.

6 comments:

I'm a 65 year old, Vietnam Combat Veteran, 1/7 Air Cavalry, 69-70. I began my PTSD and bad knee claims in May 2013. I went to a private VA approved doctor at first for my PTSD evaluation and several subsequent visits. I was given a 39 rating. In December of 2013 I guess the rules changed. The VBA sent me a packet of requested information. Some from me, and others from the doctor I had been seeing. All information was sent in on time. Then in January, the VBA sent me to VAMC C&P for another full PTSD Evaluation. This time the doctor was asking questions that the VBA were specifically asking him to include in his evaluation. Then a couple weeks later the VBA sent me to VAMC Mental Health for a treatment evaluation. I have not heard back from the VAMC as to their plan for me. Also during that time, the VBA sent me to C&P again. This time for a knee evaluation. I had active duty medical record proof for knee treatments and evaluations received during basic training and Infantry AIT from Ft.Bragg and Ft.McClellan. Again the doctor, was asking specific questions required by the VBA. It's been several weeks since, and now I'm finding out that the VBA has sent a 3d party information request again. I don't know to whom or about what. I can only guess the VAMC again. I don't see what they could possibly not know as I've given and done for them every thing I they have asked of me. I guess my question is, Why are they dragging this out? All the doctor evaluations go right into my VBA file online now. They have it the instant it is sent. Any advise???

It sounds like the VA is trying to initiate some of their new policies and practices.

They do have to have a C&P Exam (http://www.militarydisabilitymadeeasy.com/va'sc&pexam.html) done for every condition you have, and since PTSD (http://www.militarydisabilitymadeeasy.com/ptsd.html) is a specialized field (psychology), then you will have to have a separate exam for it than the one for the knee.

These exams are only for disability evaluation, though, and so do not play any role in your further treatment by the VA. That is why they sent you for an exam to the VAMC. The VAMC decides how to treat your conditions, and since you are still being treated by your VA approved physician, then the VAMC may feel that you do not need anything further from them since you are already being satisfactorily treated. I don't know that this as a fact, though, so I would contact them directly for clarification.

As for having to undergo a new round of C&P exams and them collecting additional data: The VA is in the middle of trying to clean up their big mess, and implementing new procedures. The basic idea is for them to have all the data about your case and the exact information they need to rate it. A part of this is trying to make sure that they get all the related documents from every organization (including the DoD, your outside doctors, Social Security, etc.), and in the past that has taken a great deal of time. Many of the new rules will hopefully fix this, but it is not all up and running yet. Additionally, the VA physicians aren't always properly trained with the right questions to ask, so having them conduct new C&P Exams with the right questions is meant to remedy this problem. They are trying to make sure that they have all the right information so that they can ensure that your ratings are correct.

Similarly, while they are planning on digitalizing everything, that has not been accomplished yet. Only a few VA centers have things online right now, but they are shooting to have everything online by 2015. We'll see if that happens. Hopefully it will, because that could really speed things up.

Right now all these changes may seem like a big hassle, but hopefully they'll iron themselves out and start fixing the problems. Unfortunately, you are stuck right in the middle of this revamping, so it just ends up being more of a hassle to you.

So, advice. Really all I can say is just hang tight. There isn't really much you can do to speed them up at this stage. They unfortunately just have to get things all sorted out. Once they have all the information collected, they'll update your rating to reflect any new information they receive, but there really isn't anything more you can do to get this going any faster.

As for the VAMC, I would contact them to see what their plans are for you. Again, they may feel you are being treated fine and so don't need anything else from them.

I hope this helps. I'm sorry you're being dragged through this very frustrating transitional period. I hope the VA will finally get all their stuff sorted, but unfortunately there is no guarantee.

Thank you Dr. Johnson for the response. I appreciate it very much. I called the VBA Benefits Hotline no long ago. The gentleman I talked to told me that I no longer have to go to a private doctor since the VAMC is setting up a treatment plan for my PTSD. I understand the necessity of being thorough, but I'm not sure what's left out there that they don't have already. I have a copy of my latest VAMC PTSD evaluation. They no longer have a points rating. The doctor gave me a recommendation of "greater than 50%".

I am retired and no longer working. As for my knees, in another week or so that evaluation will be available to me through Information and Records Department at our VAMC. I believe it's three weeks after an exam is completed that I can get a copy. My VA doctor has already set up an appointment for me to go to physical therapy next week. That should be something positive to confirm my condition to the VBA to use in my evaluation. I wouldn't be sent to P/T if there wasn't an issue.

I will stop by mental health next week after P/T and see what their plans are for me. I am hoping for a decision soon. I saw one time on my eBenefit claim status page that completion date was set between Nov 2014-May 2015. Hardly the 238 days goal they are claiming to approve a claim now. Thanks again!

Thank you again for the response. Let me clarify that I am no longer under any care from the private doctor. Once the VBA sent me back for a real VAMC C&P exam in early Febraury, and then again for a treatment evaluation at the Durham NC VAMC Mental Health Clinic in late March, they told me that I don't have to see the private doctor unless I want to. And to be honest, the private doctor was a rip off...little treatment but was glad to take your money. I won't be going back to him. I gained absolutely nothing but an empty bank account.

And yes, my VAMC is one of the hospitals that has immediate VBA interaction. All C&P exams that I have been through were sent in the same day I took them. I just think it would be good if the VBA could post their directives so that the individual claimant would be more informed..

Hi Michael - I totally agree! Overall, though, I think you have as good a situation as possible with the VA right now. Sad to say, I know. Just keep checking in on the status of your treatment. That's really the only thing you have any control over at the moment. Otherwise that, it's really just a waiting game, unfortunately.

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About Me

As a retired Air Force Colonel and physician, I am a Military Disability and VA Disability specialist. As a physician, I have specialties in preventive medicine, occupational medicine, and healthcare administration. While on active duty, I had direct responsibility over preventive medicine for all military members in deployed environments and contingency operations. Since retiring, I have worked as a contractor for the Physical Disability Board of Review (PDBR), reviewing military disability cases, and for the VA, performing C&P exams.